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. 2023 Feb 15;66(1):E71-E78.
doi: 10.1503/cjs.024320. Print 2023 Jan-Feb.

Patient and disease characteristics, treatment practices and oncologic outcomes among patients with colorectal cancer: a population-based analysis

Ameer Farooq  1 , Alysha R Keehn  1 , Yuan Xu  1 , Shiying Kong  1 , Winson Y Cheung  1 , May Lynn Quan  1 , Anthony R MacLean  2
Affiliations

Patient and disease characteristics, treatment practices and oncologic outcomes among patients with colorectal cancer: a population-based analysis

Ameer Farooq et al. Can J Surg. .

Abstract
in English, French

Background: The incidence of colorectal cancer (CRC) is increasing among young adults. We sought to report on patient and disease characteristics, treatment practice patterns and outcomes in this population.

Methods: We conducted a retrospective cohort study using administrative health data from the Alberta Cancer Registry (2004-2015), including demographic and tumour characteristics, and treatment received. Outcome measures included overall and cancer-specific deaths. We used Cox regression and Kaplan-Meier curves to assess for factors associated with survival.

Results: We included 18 070 patients with CRC (n = 1583 [8.8%] < 50 yr, n = 16 487 [91.2 %] ≥ 50 yr). Younger patients were more likely to present with locally advanced disease (21.0% v. 18.0%, p < 0.0001), stage III (16.4 % v. 14.6%, p < 0.0001) or metastatic (16.7% v. 13.8%, p < 0.0001) involvement. Younger patients were more likely to receive surgery (87.2% v. 80.9%, p < 0.0001), chemotherapy (59.6% v. 34.1%, p < 0.0001) or radiation therapy (49.5% v. 37.2%, p < 0.001). At 5 years, overall and cancer-specific survival was better among younger patients than older patients (30.6% v. 51.5% overall deaths, 27.5% v. 38.4% cancer-specific deaths, p < 0.0001).

Conclusion: Despite higher stage and higher grade disease, young patients with CRC had more favourable oncologic outcomes than stage-matched older patients, which may be related to younger patients receiving more aggressive treatment. Further investigation should focus on optimal treatment patterns for young patients with CRC.

Contexte:: L’incidence du cancer colorectal (CCR) est en hausse chez les jeunes adultes. Nous avons voulu faire le point sur les caractéristiques de la patientèle et de la maladie, sur les pratiques thérapeutiques et leur issue chez cette population.

Méthodes:: Nous avons procédé à une étude de cohorte rétrospective à partir des données de santé administratives de l’Alberta Cancer Registry (2004–2015), incluant les caractéristiques démographiques et les propriétés des tumeurs, de même que les traitements administrés. Les paramètres mesurés incluaient la mortalité globale et spécifique au cancer. Nous avons utilisé le modèle de régression de Cox et la courbe de Kaplan–Meier pour évaluer les facteurs associés à la survie.

Résultats:: Nous avons inclus 18 070 cas de CCR (n = 1583 [8,8 %] < 50 ans, n = 16 487 [91,2 %] ≥ 50 ans). Les patients plus jeunes étaient plus susceptibles de souffrir d’une maladie localement avancée (21,0 % c. 18,0 %, p < 0,0001), de stade III (16,4 % c. 14,6 %, p < 0,0001) ou métastatique (16,7 % c. 13,8 %, p < 0,0001). Les patients plus jeunes étaient plus susceptibles d’être traités par chirurgie (87,2 % c. 80,9 %, p < 0,0001), chimiothérapie (59,6 % c. 34,1 %, p < 0,0001) ou radiothérapie (49,5 % c. 37,2 %, p < 0,001). Après 5 ans, la survie globale et spécifique au cancer a été meilleure chez les patients plus jeunes que chez les patients plus âgés (30,6 % c. 51,5 % pour la mortalité globale et 27,5 % c. 38,4 % pour la mortalité spécifique au cancer, p < 0,0001).

Conclusion:: Malgré un stade plus avancé et un grade plus élevé, les cas de CCR chez les patients plus jeunes ont présenté une issue oncologique plus favorable que chez les patients plus âgés assortis selon le stade de la maladie, ce qui peut s’expliquer du fait que les patients plus jeunes ont reçu un traitement plus agressif. Il faudra approfondir la recherche sur les pratiques thérapeutiques optimales chez les patients jeunes atteints de CCR.

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Conflict of interest statement

Competing interests: Ameer Farooq is the associate digital editor for CJS; he was not involved in the review or decision to accept this manuscript for publication. He is also codirector of social media for Evidence Based Reviews in Surgery. No other competing interests were declared.

Figures

Fig. 1
Fig. 1
Study flowchart. CRC = colorectal cancer.
Fig. 2
Fig. 2
Unadjusted Kaplan–Meier curves for (A) overall and (B) cancer-specific survival.
Fig. 3
Fig. 3
Multivariable Kaplan–Meier curves for (A) overall and (B) cancer-specific survival, adjusted for sex, Charlson Comorbidity Index, year of diagnosis, mean neighbourhood income and education level, tumour location, stage, grade, receipt of surgery, receipt of chemotherapy, receipt of radiation therapy and institution where treatment was delivered.
See this image and copyright information in PMC

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